Since the introduction of the first implantable pacemakers in the 1960s, there have been considerable advancements in both the field of electronics and of medicine, such that there is presently a wide assortment of commercially available body-implantable electronic medical devices. The class of implantable medical devices now includes pacemakers, but also implantable cardioverters, defibrillators, neural stimulators, drug administering devices, insertable loop recorders, or physiologic monitors among others. Today's state-of-the-art implantable medical devices are vastly more sophisticated and complex than early ones, capable of performing significantly more complex tasks. The therapeutic benefits of such devices have been well proven.
As the functional sophistication and complexity of implantable medical device systems have increased over the years, it has become increasingly more important to include a system for facilitating communication between one implanted device and another implanted or external device, for example, a programming console, monitoring system, or the like.
Shortly after the introduction of the earliest fixed-rate, non-inhibited pacemakers, it became apparent that it would be desirable for physicians to noninvasively obtain information regarding the operational status of the implanted device, and/or to exercise at least some control over the device, e.g., to turn the device on or off or adjust the fixed pacing rate, after implant. Initially, communication between an implanted device and the external world was primarily indirect. For example, information about the operational status of an implanted device could be communicated via the electrocardiogram of the patient by modulating the rate of delivery of stimulating pulses in some manner. This was the case for the Medtronic Spectrax™, circa 1979, for which a 10% change in pacing rate was used to indicate battery status. This method could only provide a very low data rate transmission without interfering with the clinical application of the device. An early method for communicating information to an implanted device was through the provision of a magnetic reed switch in the implantable device. After implant, placing a magnet over the implant site would actuate the reed switch. Reed switch closure could then be used, for example, to alternately activate or deactivate the device. Alternatively, the fixed pacing rate of the device could be adjusted up or down by incremental amounts based upon the duration of reed switch closure.
Over time, many different schemes utilizing a reed switch to adjust parameters of implanted medical devices have been developed. See, for example, U.S. Pat. No. 3,311,111 to Bowers, U.S. Pat. No. 3,518,997 to Sessions, U.S. Pat. No. 3,623,486 to Berkovits, U.S. Pat. No. 3,631,860 to Lopin, U.S. Pat. No. 3,738,369 to Adams et al., U.S. Pat. No. 3,805,796 to Terry, Jr., and U.S. Pat. No. 4,066,086 to Alferness et al.
As new, more advanced features have been incorporated into implantable devices, it has been increasingly necessary to convey correspondingly more information to the device relating to the selection and control of those features. For example, if a pacemaker is selectively operable in various pacing modes (e.g., VVI, VDD, DDD, etc.), it is desirable that the physician or clinician be able to non-invasively select a mode of operation. Similarly, if the pacemaker is capable of pacing at various rates, or of delivering stimulating pulses of varying energy levels, it is desirable that the physician or clinician be able to select, on a patient-by-patient basis, appropriate values for such variable operational parameters.
Even greater demands are placed upon the communication system in implantable devices having such advanced features as rate adaptation based upon activity sensing, as disclosed, for example, in U.S. Pat. No. 5,052,388 to Sivula et al. entitled “Method and Apparatus for Implementing Activity Sensing in a Pulse Generator”, or in U.S. Pat. No. 5,271,395 to Wahlstrand et al. entitled “Method and Apparatus for Rate-Responsive Cardiac Pacing.” The Sivula et al. '388 and Wahlstrand et al. 395 patents are each hereby incorporated by reference herein in their respective entireties.
The information communicated to the implantable device in today's state-of-the-art pacemakers can include: pacing mode, multiple rate response settings, electrode polarity, maximum and minimum pacing rates, output energy (output pulse width and/or output pulse amplitude), sense amplifier sensitivity, refractory periods, calibration information, rate response attack (acceleration) and decay (deceleration), onset detection criteria, and many other parameter settings.
The need to be able to communicate more and more information to implanted devices (i.e., to establish “downlink” communication channels) quickly rendered the simple reed-switch closure arrangement inadequate. Also, it has become apparent that it would also be desirable not only to allow information to be communicated to the implanted device, but also to enable the implanted device to communicate information to the outside world (i.e., to establish “uplink” communication channels). (As used herein, the terms “uplink” and “uplink communication” will be used to denote the communications channel for conveying information from the implanted device to an external unit of some sort. Conversely, the terms “downlink” and “downlink communication” will be used to denote the communications channel for conveying information from an external unit to the implanted device. Although this terminology assumes that communication is occurring between an implanted device and an external device, it is contemplated that the communication system described herein is equally useful and beneficial in situations where communication occurs between any two or more devices, whether some are implanted and others are implanted, or all are implanted, or all are external.)
For diagnostic purposes, it is desirable for the implanted device to be able to communicate information regarding the device's operational status and the patient's condition to the physician or clinician. State of the art implantable devices are available which can even transmit a digitized electrical signal reflecting electrical cardiac activity (e.g., an ECG, EGM, or the like) for display, storage, and/or analysis by an external device. In addition, known pacemaker systems have been provided with what is referred to as Marker Channel™ functionality, in which uplink information regarding the pacemaker's operation and the occurrence of physiological events is communicated to an external programming unit. The Marker Channel™ information can then be printed or displayed in relation to an ECG so as to provide supplemental information regarding pacemaker operation. For example, events such as pacing or sensing of natural heartbeats are recorded with a mark indicating the time of the event relative to the ECG. This is helpful to the physician in interpreting the ECG, and in verifying proper operation of the pacemaker. One example of a Marker Channel™ system is disclosed in U.S. Pat. No. 4,374,382 to Markowitz, entitled “Marker Channel Telemetry System for a Medical Device.” The Markowitz '382 patent is hereby incorporated by reference herein in its entirety.
Existing systems, which provide a Marker Channel™ output, operate basically by outputting an indication of a physiological or pacemaker event, e.g., a delivered stimulating pulse or a sensed heartbeat, at about the time of the event, thereby inherently providing the timing of the event in relation to the recorded ECG. Alternatively, the Marker Channel™ system can accumulate data over a period of time, e.g., one cardiac cycle, and transmit a batch of data for that interval at the beginning of the next interval. This is what appears to be proposed in U.S. Pat. No. 4,601,291 to Boute et al., entitled “Biomedical System with Improved Marker Channel Means and Method.”
Typically, communication with an implanted medical device (IMD) has been employed in conjunction with an external programming/processing unit. One programmer for non-invasively programming a cardiac pacemaker is described in its various aspects in the following U.S. Patents to Hartlaub et al., each commonly assigned to the assignee of the present invention and each incorporated by reference herein: U.S. Pat. No. 4,250,884 entitled “Apparatus For and Method Of Programming the Minimum Energy Threshold for Pacing Pulses to be Applied to a Patient's Heart”; U.S. Pat. No. 4,273,132 entitled “Digital Cardiac Pacemaker with Threshold Margin Check”; U.S. Pat. No. 4,273,133 entitled Programmable Digital Cardiac Pacemaker with Means to Override Effects of Reed Switch Closure”; U.S. Pat. No. 4,233,985 entitled “Multi-Mode Programmable Digital Cardiac Pacemaker”; U.S. Pat. No. 4,253,466 entitled “Temporary and Permanent Programmable Digital Cardiac Pacemaker”; and U.S. Pat. No. 4,401,120 entitled “Digital Cardiac Pacemaker with Program Acceptance Indicator”.
Aspects of the programmer that are the subject of the foregoing Hartlaub et al. patents (hereinafter “the Hartlaub programmer”) are also described in U.S. Pat. No. 4,208,008 to Smith, entitled “Pacing Generator Programming Apparatus Including Error Detection Means” and in U.S. Pat. No. 4,236,524 to Powell et al., entitled “Program Testing Apparatus”. The Smith '008 and Powell et al. '524 patents are also incorporated by reference herein in their entirety.
Heretofore, three basic techniques have been used for telemetered communication in an implantable device system: magnetic field coupling, reflected impedance coupling, and radio-frequency (RF) coupling. In static magnetic field coupling, of which the above-described Bowers '111 patent is an example, a static magnetic field is generated external to the medical device, e.g., using a permanent magnet, having sufficient strength to close a magnetic reed switch within the implanted device. While such a technique provides a fairly reliable mechanism for turning various functions within the implanted device on or off, the technique is, as noted above, much too slow for efficiently transferring any significant amount of data. Furthermore, for all practical purposes, the static magnetic system is useful only for downlink communication, not for uplink communication. Despite the limitations of magnetic coupling downlink communication, its simplicity and reliability are such that such arrangements can be found even in current devices, for example, the Medtronic Itrel II implantable neural stimulator, as substantially described in U.S. Pat. No. 4,520,825 to Thompson et al.
Dynamic magnetic field programming, on the other hand, relies upon the generation of a series of strong magnetic impulses, which periodically actuate a magnetic reed switch inside the implanted device. The output of the reed switch circuit forms the programming input to data registers in the implantable device, as shown, for example, in the above-referenced to Terry, Jr. et al. '796 patent. Such arrangements have several limitations, including the rate at which strong magnetic impulses can be generated (several hundred hertz or so), the physical size of the reed switch and magnet, the sensitivity to magnetic field orientation, and necessity of generating the impulses in very close proximity to the implanted device.
In a reflected impedance coupling system, information is transferred using the reflected impedance of an internal (implanted) L-R or L-C circuit RF energized by an inductively coupled, external, L-R or L-C circuit. Such a system is shown, for example, in U.S. Pat. No. 4,223,679 to Schulman et al. Advantageously, such a system uses little or no current to transmit information. Disadvantageously, however, the maximum data rate of reflected impedance-coupling systems is relatively slow, and the distance or rate at which information may be transferred is limited.
In RF coupled systems, which are perhaps the most commonly employed communication systems in modem implantable device systems, information is transferred from a transmitting coil to a receiving coil by way of a radio-frequency carrier signal. The carrier signal is modulated with the data that is to be transmitted using an appropriate modulation scheme, such as phase shift keying (PSK), frequency shift keying (FSK), or pulse position modulation (PPM), among numerous others. The modulated carrier induces a voltage in the receiving coil that tracks the modulated carrier signal. This received signal is then demodulated in order to recover the transmitted data. Because the stainless steel or titanium canister commonly used to hermetically enclose an implanted device acts as a low-pass filter for the transmitted RF signals, attenuation increases as frequency is increased. Devices currently on the market have a maximum frequency of less than 200-kHz. Also, the transmitting range has been limited to 2- to 3-inches or so.
High performance telemetry communications systems used in sensor and signaling applications allow a high level of integration, as every component of the telemetry system is realized in a single semiconductor integrated circuit. The lack of external tuned circuits in such telemetry systems dictates the use of a very broadband receiver front end with a high dynamic range, which makes the receiver especially susceptible to strong out-of-band electromagnetic interference (EMI) from such sources as television, FM and business bands, and two-way, cellular, or PCS radio transmitters. Though intermittent, EMI may potentially degrade the telemetry communications link. Additionally, EMI may overload or interfere with the implant's sensors and sensor amplifiers thereby causing spurious therapy outputs, or inhibiting required therapy output, based on erroneous sensor data. High-level (order) EMI interference detectors may be used to inhibit spurious therapy in this case. Alternately, RF (low-pass, high-pass, or notch) filtering can also be applied to sensor inputs of the implant to filter out the EMI interference and retain normal device performance. However, retaining full telemetry link performance under large EMI interference requires attenuation of the interfering signal while not attenuating the telemetry signal. Typically this is done via RF band-pass filtering at the receiver front-end for strong out-of-band interferors. Additionally, a very narrow (at least one channel bandwidth) tunable preselector (band-pass) filter, or an RF notch filter can be used to reject narrow in-band or out-of-band interference. In this way, EMI interference to the telemetry link can be minimized or eliminated.
The majority of front end high Q bandpass filters used in radio frequency (RF) and intermediate frequency (IF) stages of heterodyning transceivers use off-chip, mechanically resonant components such as crystal filters, helical filters, or surface acoustic wave (SAW) resonators. These greatly outperform comparable devices using transistor technologies in terms of insertion loss, percent bandwidth, and achievable rejection of noise signals. SAW resonators can be combined with signal processing and spread spectrum technologies for high rejection against jamming and interference. Advantages are high sensitivity, high reliability, and a moderate size of 1 cm2.
Off-chip components are required to interface with integrated components at the board level, which constitutes an important bottleneck to miniaturization and the performance of heterodyning transceivers. Recent attempts to achieve single chip transceivers have used direct conversion architectures, rather than heterodyning and have suffered in overall performance. The continued growth of micromachining technologies, which yield high-Q on-chip vibrating mechanical resonators now make miniaturized, single-chip heterodyning transceivers possible. Thin film bulk acoustic resonator (FBAR) yield ultra high Qs of over 80,000 under vacuum and center frequency temperature coefficients less than 10 ppm/° C. and serve well as a substitute for crystal filters and SAW devices in a variety of high-Q oscillator and filtering applications. FBAR resonators are capable of frequency operation to GHz levels and filtering operation up to the 6th order.